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Neuroscience > Prosthetics Day 3 > Flashcards

Prosthetics Day 3 Flashcards

1
Q

Medicare functional classification levels: K0

A

no ambulatory potential with or w/o prosthesis- no reason for a prosthesis

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2
Q

Medicare functional classification levels: K1

A

Low level: prosthesis would allow limited ambulation in household on level surface w/ little cadence change

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3
Q

Medicare functional classification levels: K2

A

low level/ limited community ambulator, can perform steps and curbs, some cadence change

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4
Q

Medicare functional classification levels: K3

A

independent community ambulator w/ varying cadence and activity levels; needed for full participation in vocational or leisure activities

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5
Q

Medicare functional classification levels: K4

A

High level full independence in vocational or sports/leisure activity

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6
Q

AMPnoPro tests with or without prosthetic?

A

w/o prosthetic

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7
Q

What does the AMPpro test?

A

WITH prosthetic

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8
Q

how many points do you need on the AMPpro test to qualify for a microprocessor

A

37/47

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9
Q

pre-prosthetic interventions for girth and shape?

A

De-sensitization, elevation (dec swelling), scar tissue massage = wrapping is necessary for first 3-4 week

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10
Q

when do you wear a shrinker (elastic sock)?

A

Always except for showering and when stiches are removed for up to a year post surgery to control swelling, help in shaping and promote healing.

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11
Q

for a transfemoral amputation, to increase ROM what two hip muscles would you want to stretch to prevent hip contractures?

A

Hip flexors- prone press ups (contraction from wheelchair)
hip abductors exercises- since amputation can drift outward and get contracted

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12
Q

for a transtibial amputation (below the knee), what muscle groups would you want to stretch?

A

hip flexors, hip abductors, + hamstrings (can do this by putting board under leg in wheelchair- we want them to extend to prevent knee contractures)

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13
Q

what sitting position of the hip is common in amputee pts? How can we address this sitting position?

A

FLX, ABD, ER of the hip
can use a strap around knee to stretch hamstrings and keep leg flat against board

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14
Q

what muscle groups would you work on strengthening if you had a TT for pre prosthetic ROM?

A

hip abductors, hip extensors, quads

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15
Q

what muscle groups would you work on strengthening if you had a TF (above the knee) for pre prosthetic ROM? for walking

A

Hip ABD, hip ext (determines gait speed)

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16
Q

what muscle groups would you work on strengthening if you had an UE amputation for pre-prosthetic interventions?

A

triceps and lower traps (closed chain)

Keep UE strength a priority.

Prevent impingement and overuse injuries ie. carpal tunnel, intact limb overuse, LBP

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17
Q

How would managing overuse secondary to the assistive device look like in the thorax for pre-prosthetic interventions?

A

trunk management- flexion position all the time- do trunk extension and work on core because people collapse

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18
Q

How would managing overuse secondary to the assistive device look like in the INTACT limb in pre-prosthetic interventions?

A

manage impact and overuse- invest in good sneakers/shoes

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19
Q

What are some types of pre- prosthetic interventions categories?

A
  1. balance
  2. transfers
  3. ADL’s
  4. Locomotion without prosthesis (ambulation w/ AD), fall risk?
  5. WC mobility- can they manage own wheelchair?
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20
Q

Phantom sensation vs phantom pain?

A

Phantom sensation- hurts a lot with limb still there
- you can do de-sensitization things like: TENS, tapping, massage, acupuncture, shrinker, prosthetic usage

Phantom pain- hurts with no limb present

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21
Q

what is the targeted muscle re-innervation?

A

Surgical procedure for the prevention or treatment of neuroma to help phantom limb pain. Nerves in the LE amputation can be transferred to more proximal motor points or buried to prevent neuromas from developing

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22
Q

What is myodesis?

A

a surgical procedure where the muscles are attached directly to the bone in an amputation surgery. Provides better stabilization for ischemic limbs

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23
Q

what is myoplasty

A

Involves suturing muscles together, typically opposing muscle pairs like flexors and extensors.The goal is to create a soft tissue covering over the amputation stump.Myoplasty should be avoided in the digits because it can compromise motion.

muscle is attached to muscle then placed over the end of the bone for distal muscle stabilization

helps to stabilize them and helps stabilize socket

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24
Q

BONE BRIDGE – Ertl Procedure

A

Bone bridge amputation surgery, also known as the Ertl procedure, isa surgical technique that involves creating a bone bridge between the tibia and fibula during a transtibial amputation so they can weight bear

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25
Q

INTERVENTIONS WITH A PROSTHESIS

A
  1. Wearing Time (why???) Set up a schedule!!
  2. Don & Doff with Skin Inspection- how to put it on and off properly- bad vs good pressure areas, how to know if its on properly, sock management
  3. Educate the amputee about their prosthesis: components and how to take care of them so no infections
  4. Balance & Coordination
  5. Gait Training
  6. Functional Activities – Floor Transfers, bathroom transfers
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26
Q

What are some components that include donning a prosthesis? making sure it fits

A
  1. Fabric liners- do not need alcohol
  2. They shrink throughout the day- pressure= fluid moves= More socks to lift up to the spot where they are supposed to be
  3. Initial phase- still changing- socks
  4. Want gel liner to adhere to skin
    - other parts sweat excessively after amputation- because they lost a part of their body that sweats- hidrosis- liner fabric depend
    - Condyles are used for suspensions- socks keep a tight fit
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27
Q

steps in donning

A
  1. Put on liner inside out- when you roll it is right side (No bubbles- important- biggest thing they do that is wrong). If there is air- sucks on bottom of limb- blisters
  2. Rings of liner are unfolded and around
  3. Seal in liner- tightly, of rings- rings needs to be tight- the rings seal- you have to push it tightly, but it can’t go all the way to the bottom
  4. Rubbing alc mixture- squirt inside prosthetic
  5. Push in
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28
Q

examples of balance and coordination exercises

A
  1. sit to stand
  2. diagonal, AP, ML wt shifting
  3. swing and stance motions
  4. step ups and step overs w/ sound limb
  5. single leg stance
  6. standing- reactive and anticipatory
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29
Q

Functional Activities

A

transfers – all types, all surfaces
ramps/inclines
stair climbing
kneeling
ADLs, IADLs (lift and carry)
work skills/tasks
running/sports/recreation

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30
Q

pt ed examples- pertaining to prosthetic management

A
  • sock management:
    wear/keep socks clean
    Jammed into bottom, hear pistoling (air)- need another sock, proper number of socks
    proper fit/ # ply / donning & doffing
  • hygiene: skin, socket, cover, liners, sleeves
    skin care: check skin frequently (mirror), prevent problems (sweat), do you know you have a callous here? Do not feel it in good foot.
  • wearing time: increase gradually
    wrap/shrinker when not wearing prosthesis
  • positioning: prone- good for back, prevents hips flexion contractures- but no one likes it= have them do it, stretching, HEP
  • component care: charging, battery life, default modes, waterproof, warranty
  • any problems – discomfort, skin, noises, etc. – see prosthetist, PT, or MD
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31
Q

unilateral transtibial oxygen use

A

slight increase O2 than normal

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32
Q

unilateral transfemoral- O2

A

50% more O2 than normal

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33
Q

dysvascular prosthetic user

A

Use more O2 than traumatic counterparts

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34
Q

Assessment of Prosthetic Fit and Function: Sitting

A
  1. Identify/evaluate each of the types of prosthetic componentry and suspension- this was fitted last week, how did thy show you how to put it on?
  2. How many ply socks does the patient have on?
  3. Can the patient don the prosthesis easily/independently?
  4. Is the person comfortable in sitting?
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35
Q

Assessment of Prosthetic Fit and Function: Standing

A
  1. Check the foot position too inset or too outset?
  2. Is the foot flat on the floor? It should be flat on the floor- not too far in front or behind
    Is there excessive lean of the pylon forward or to the side?
  3. Is there overall balance and symmetry between the two legs?
    ‘
  4. Height is lower- develop back pain and bed happens- you should not make prosthetics shorter for it to be easier to clear- good therapy, you will be okay w/o making it shorter
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36
Q

Assessment of Prosthetic Fit and Function/ Standing

A

Is the person comfortable in standing with an approximate 6” BOS?
6. Does the leg length seem equal?
7. Is the prosthetic knee stable in standing?

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37
Q

Assessment of Prosthetic Fit and Function Standing

A
  1. Is the ischium contained within the socket?
    If there is something wrong, they could have lateral trunk lean, this is important to be even
  2. Is there any flesh roll above the socket on any side?
    Abductor area- common- bc of poor wrapping or poor shrinking
  3. Is there any vertical pressure in the perineum?
  4. Is the amputee’s limb able to get fully into the socket?

Gain weight more than 10 lbs or loose 10 lbs after fitted for prosthesis- will not fit in socket

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38
Q

Assessment of Prosthetic Fit and FunctionWalking

A

Is there any pistoning- Noises (air escape during sit to stand)
when lifting and lowering the prosthetic limb?

Are they moving up and down and side to side?

Is there any pinching or gapping of the socket?

Does the suspension function effectively? Is it keeping on them properly or falling off

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39
Q

prosthetic gait examination components

A
  1. use of assistive device- least amount for safety
  2. transfers- on varied surfaces, varied heights, varied directions
  3. Gait deviations- observe from all directions, prosthetic vs anatomic
  4. stairs, curbs, ramps- ascend and descend
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40
Q

what outcome measure test can be used to assess mobility?

A

TUG
four step square test
figure 8 walking
5x Sit to stand

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41
Q

what outcome measure test can be used to assess gait?

A

Gait speed- 2 minute walk test or 6 minute walk test

42
Q

5 Ways to preserve the remaining foot

A
  1. pt and family education about foot care
  2. Wound care
  3. protective footwear
  4. shoe modifications
  5. unloading devices (AD)
43
Q

ulcer prevention

A
  1. no slippers- proper footwear
  2. custom shoes molded orthotics
  3. daily inspection
  4. assistive devices to decrease WB
  5. Minimize gait deviations
44
Q

steps in assessing the foot

A
  1. skin inspection
  2. check pulse
  3. check sensation
  4. thorough medical history
  5. foot deformity
  6. stage the wound
45
Q

4 levels of wound staging

A
  1. redness of skin, but not broken or open sore yet
  2. partial thickness tear… blister
  3. full thickness tear but now through subcutaneous tissue
  4. Deeper structures (into muscle, ligs, tendon)
46
Q

purposes of shoe modifications

A
  1. distribute weight bearing forces over a large area
  2. reduce stress on remaining foot
  3. promote healing through pressure relief
  4. allow safer mobility and function
47
Q

what is a transmetatarsal amp technique

A

a surgical procedure that removes the forefoot at the level of the metatarsal shafts. Foot cut in the middle of the metatarsals.

salvages rest of limb, Preserves a weight-bearing platform, allowing for early ambulation and maintaining independence

48
Q

Lisfranc Amputation

A

amputation after 2 carpal rows (cuneiform and cuboid bones) of bones and before metatarsals

can be a good option because it preserves limb length, which allows for a higher level of ambulation. However, it can result in a short amputation stump that can cause muscle imbalance and foot drop

49
Q

Chopart amputation

A

removes the forefoot and midfoot, saving talus and calcaneus

controversial procedure that’s considered unstable because most of the tendons around the ankle joint are no longer attached to the foot

50
Q

Syme Amputation

A

Disarticulates the talocrural joint and trims malleoli for a flat weight bearing surface

removes the foot through the ankle joint while preserving the heel pad

51
Q

what is charco foot/ diabetic neuropathic osteoarthropathy?

A

ds that attacks the bones, joints, and soft tissue in your feet. Can cause painful sores and change shape of your feet. Affects people who cannot feel anything bc of nerve damage. Leads to severe joint deformities.

52
Q

what is a removeable cast walker

A

a knee-high offloading device that allows patients to walk while reducing pressure on a wound. RCWs are used to treat diabetes-related foot ulcers (DRFUs) and can also help improve balance

(a boot) not cast- what they would give for gymnastics

52
Q

off loading strategies

A
  1. total contact cast- regular cast with brace holding it on outside to allow walking
  2. posterior walking splint - splint b=made just for back of calf
  3. removeable cast walkers- a boot (what they gave for gymnastics)
  4. calf corset- lace up orthosis with custom rocker shoe on the bottom
  5. Arizona orthosis (lace up boot like a brace)
52
Q

posterior walking splint

A

A posterior walking splint extends from the metatarsal heads or great toe’s plantar surface, down the lower leg’s posterior side. It ends about two inches below the fibular head to avoid putting pressure on the common peroneal nerve.

Splints can provide similar pressure relief to a cast, but they’re easier to remove and can be adjusted to accommodate swelling. They’re also less likely to cause complications than casts

53
Q

total contact cast

A

a non-removable cast that’s used to treat foot conditions and redistribute pressure on the foot

54
Q

guidelines for preventative footcare:

A
  1. wash and dry feet + b/w toes
  2. moisturize feet, not toes
  3. trim toenails after washing and drying feet
  4. have podiatrist address any ingrown toenails
  5. manage corns/callouses
  6. check water temp for bath
  7. use sunscreen on top of feet during summer
  8. wear socks at night if feet are cold
  9. ask healthcare provider to check feet at each level
55
Q

self foot inspection

A
  1. inspect al surfaces of the feet daily (including b/w the toes) for signs of injury
  2. report any injuries to a health care provider immediately
  3. feel for increased areas of temperature
  4. check for tender areas on bottom of feet
  5. use a mirror if necessary to see bottom of feet
  6. have someone check feet for you
56
Q

footwear care

A
  1. wear shoes that fit the shape and size of feet and leave room for any insoles
  2. ask healthcare provider to recommend correct type of shoe
  3. break in new shoes slowly
  4. keep shoes and insoles in good repair
  5. always wear socks or stockings with shoes, wearing a clean pair daily
  6. before putting dshoes on, check for rough areas, torn linings, or loose objects that can injure the foot
57
Q

prosthetic management education components

A
  1. correct donning and doffing wearing schedule
  2. sock management/skin inspection/shrinker
  3. how do they components works?
  4. care of the prosthetics: cleaning, charging, maintenance
58
Q

LLD stands for and can cause what body asymmetries

A

Leg Length Discrepancy- Limping or toe-walking
Back, hip, knee, or ankle pain
A tilted shoulder
A chronically hyperextended knee on the short side and flexed on the long side

59
Q

if the prosthesis is too short there will be decrease _________ __________ ____________________

A

transverse pelvic rotation

60
Q

if the prosthesis is too short there will be decrease _____ __________ which causes ____________________

A

knee flexion; vaulting

61
Q

gait training- muscles that assist in weight acceptance

A

Hip extensors, dorsiflexor’s, quadriceps

62
Q

gait training- muscles that assist in single limb support

A

Abdominals, back extensors, hip abductor, plantar flexors

63
Q

gait training- muscles that assist in swing phase

A

hip flexors, adductors, back extensors

64
Q

ambulation problems

A

sound limb is biased to midline, decreased toe load, decreased prosthetic knee flexion, decreased pelvic rotation

65
Q

long term higher loading, repetitive forces on one single limb can lead to premature

A
  1. osteoarthritis
  2. excess pain
  3. overuse injuries/breakdown
66
Q

what are the 6 determinants of gait?

A
  1. step width
  2. step length
  3. toe load
  4. knee flexion
  5. pelvic rotation
  6. trunk rotation
67
Q

difference between heel strikes of 2 CONSECUTIVE foot contacts is which component of gait determinants?

A

step width

68
Q

step width can be affected by Adducted ______ limb and abducted _______ limb

A

adducted sound limb, abducted prosthetic limb and this can be due to habit, weakness or poor balance

69
Q

difference between 2 DIFFERENT feet is which component of gait determinants?

A

step length

70
Q

what is a step length deviation and its probable cause?

A

prosthetic to sound limb can have shorter step lengths due to fear, inability to balance over the prosthesis, pain or discomfort

71
Q

what is toe load/toe off and what are normative values of toe ext?

A

normative values of toe ext- 20-55 degrees

Toe-off, or pre-swing, isthe final phase of stance in the gait cycle and occurs when the toe is lifted off the ground.It’s the moment when the body weight shifts from the rear leg to the front leg, and the swing phase begins

72
Q

A toe load deviation would include a lack of toe break or toe off to propel you forward which can be due to what 4 things?

A
  1. lack of pelvic floor rotation
  2. poor balance
  3. lack of hip extension
  4. contracture of flexors
73
Q

how much knee flexion should you have during pre swing?

A

30-40 degrees

74
Q

how much knee flexion should you have during initial swing?

A

should have more flexion of knee at initial swing because you need to start swinging and clear the ground- 60 degrees

75
Q

Deviation would be lack of knee flexion due to what 3 probable causes?

A
  1. decreased pelvic rotation
  2. unable to roll over the toe
  3. prosthesis is too short
76
Q

pelvic rotation normative values

A

5 degrees forward both sides

77
Q

what is the pelvic rotation gait deviation?

A

prosthetic side rotates posteriorly

78
Q

what are 2 causes for the pelvic rotation?

A
  1. lack of pelvic transverse rotation
  2. limb length deficiency- short
79
Q

trunk rotation normative value

A

5 degrees in opposition to the pelvis

80
Q

what from the upper body will cause a trunk rotation deviation?

A

Asymmetrical arm swing

81
Q

what are some probable causes for a trunk rotation deviation?

A
  1. inability to balance over the prosthesis
  2. habit
  3. assistive device
82
Q

4 benefits of symmetrical arm swing

A
  1. improved balance
  2. energy efficiency- conserves energy
  3. improved forward momentum
  4. natural looking gait
83
Q

What is a common gait deviation relating to the trunk?

A
  1. improving trunk rot decreases lat trunk lean
  2. controlled SLS lessens lat trunk lean
  3. timely gluteal activation lessens lean
  4. hip ext, hip abd, core muscles- strengthen
84
Q

3 Hip extensor functions

A
  1. predictor of gait speed
  2. push over prosthetic foot- aids inpropulsion
  3. Contract from initial contact to midstance for pelvic control
85
Q

Hip abductors functions

A
  1. improves balance in stance (w/ hip extensors)
  2. contract from midstance to terminal stance to control pelvic tilt
86
Q

______ _______ _______ is good predictor for ambulation and balance in amputee population

A

Single Limb Standing

87
Q

6 prosthetic gait training goals

A
  1. minimize gait deviations
  2. symmetry- equal step lengths, timing
  3. safety
  4. maximize prosthetic performance
  5. improve function
  6. energy efficiency
88
Q

PT interventions

A
  1. postural re-ed
  2. balance training- static and dynamic
  3. weight shift/acceptance
  4. restore trunk and pelvic rotation
  5. strengthening/timely muscle activation
89
Q

What are the 3 types of phantom sensation?

A
  1. movement - willed/controlled or spontaneous- missing limb is moving; toes curled
  2. kinesthetic-feeling like it is in a certain position; size/shape/position- hand is twisted when it it not
  3. exteroceptive- pressure, touch, tingling, temp, vibration, itching
90
Q

what are the classification levels of LE amputations?

A
  1. transtibial
  2. transfemoral
  3. knee disartic,
    partial foot (symes?)
  4. Hip disartic
91
Q

What is the purpose of classification levels such as K levels- K0, K1 etc?

A

medicare functional classification levels- validate need for PT ad used for insurance

92
Q

Which K level is regarded as functional for insurances approval?

A

K3

93
Q

what is the max score for an AMPnoPRO

A

43

94
Q

What is the max score for an AMPPRO?

A

47

95
Q

AMPnoPRO scores for K0-K4 (w/o prosthesis)

A

K0-K1= 9.67
K2= 25.28
K3= 31.36
K4= 38.49

96
Q

AMPPRO scores for K0-K4 (w/ prosthesis)

A

K0-K1= 25
K2= 34.65
K3= 40.50
K4= 44.67

97
Q

how long can swelling last after amputation?

A

1 year

98
Q

when your stiches are removed you can wear _______ to help with girth and shaping for pre-prosthetic interventions

A

shrinker (sock)

99
Q
A

Neuroscience (6 decks)

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